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Adult Health 3 > Test 4 - Cardiac > Flashcards

Test 4 - Cardiac Flashcards

1
Q

What are the key ions for Cardiac function?

A

Sodium: rapid influx
Potassium: leaves cells
Calcium: slow influx

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2
Q

What is the function of the ions Na/K?

A

Initiation of muscle contraction

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3
Q

What is the function of the ion Ca?

A

To strengthen contractility

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4
Q

What is the order of signals being sent by the heart?

A

SA Node
AV Node
Bundle of His
Right/Left Bundle Branches

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5
Q

What bpm can be stimulated by SA node function?

A

60 - 100 bpm

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6
Q

What bpm can be stimulated by AV node function?

A

40 - 60 bpm

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7
Q

What bpm can be stimulated infranodally (below the nodes)?

A

20 - 40 bpm

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8
Q

What do Beta-1 receptors target?

A

Increase HR and contractility

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9
Q

What do Beta-2 receptors target?

A

Bronchodilation

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10
Q

What do Alpha receptors target?

A

Vasoconstriction and increased contractility

no HR increase

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11
Q

What happens during the “P Wave?”

A

Atrial depolarization

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12
Q

What happens during the “QRS Complex?”

A

Ventricle depolarization

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13
Q

What happens during the “T Wave?”

A

Ventricular repolarization (rest)

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14
Q

What happens if a patient is shocked on a “T wave?”

A

Ventricular Dysrhythmias

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15
Q

Bradycardia: Causes

A

Athletes, during sleep, in response to vagal stimulus, inferior MI

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16
Q

What is Bradycardia a S/E of?

A 
Beta Blockers
Digoxin
Calcium Channel Blockers
Inferior MI
Hypoxia
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17
Q

Bradycardia: Treatment

A

Only treat if symptomatic (get rid of cause)

Sequence: Atropine -> Pacemaker -> Dopamine -> Epi

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18
Q

Tachycardia: Causes

A

Physical activity, pain, stress, fear, hypoxemia, hyperthyroid, caffeine, ETOH, nicotine

Compensatory response to decreased CO or BP

Tx: treat cause

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19
Q

A Fib and A Flutter: increased risk

A

Increased risk of clots and stroke

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20
Q

A Fib and A Flutter: Treatment

A

-Reduce ventricular rate
Ca Channel Blocker, Amiodarone, Beta blockers, digoxin

-Cardioversion: onset <48 hrs prior
-Anticoagulants: onset >48 hrs prior
Check coag studies, TEE

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21
Q

Chronic A Fib Treatment

A

-Coumadin, Pradaxa, Xarelto

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22
Q

SVT/PSVT

A

No P wave
HR >150 bpm
Narrow QRS

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23
Q

SVT/PSVT: Causes

A
  • Stress
  • Caffeine
  • Cocaine/ETOH abuse
  • Rheumatic HD
  • MI
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24
Q

SVT/PSVT: S/S

A
  • SOB
  • Chest tightness
  • Palpitation
  • Dizziness
  • Hypotension
  • Syncope
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25
Q

SVT/PSVT: Treatment

A
  • Get rid of underlying cause
  • “Bear down” = vagal stimulation
  • Adenosine (Adenocard)

If unstable/symptomatic: immediate cardioversion

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26
Q

First Degree Heart Block: Treatment

A

Atropine

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27
Q

Mobitz I/Wenckebach: Treatment

A

Atropine if symptomatic

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28
Q

Mobitz II and Third Degree Heart Block: Treatment

A

Pacemaker

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29
Q

PVC: Treatment

A
  • Eliminating contributing factors (i.e. stress and caffeine)
  • Other factors: dig toxicity, hypoxia, HF, E-lyte imbalance (especially hypokalemia)

Meds: Amiodarone and Lidocaine

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30
Q

PVC: Care

A

Report increased frequency of PVCs

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31
Q

Stable (normal BP) V. Tach with Pulse: Treatment

A
  • Notify HCP/Call a Rapid
  • Amiodarone

Torsade’s V. Tach Tx: Mg

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32
Q

Unstable (low BP) V. Tach with Pulse: Treatment

A
  • Cardioversion IMMEDIATELY

- Amiodarone

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33
Q

What causes Torsade’s de Pointes?

A

Low magnesium (<1.3)

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34
Q

V. Tach without a pulse

A
  • CPR
  • Defibrillation ASAP
  • Epi
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35
Q

V. Fib Treatment Sequence

A

CPR
Defibrillate
Epi

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36
Q

V. Fib Meds

A

Epi: 1 mg q3-5 min
Amiodarone
Lidocaine
Magnesium Sulfate (if Torsade’s or low Mg)

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37
Q

Pulseless Electrical Activity Care

A

CPR
Treat causes
Epi

DO NOT SHOCK asystole or PEA

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38
Q

Causes of PEA: 6 H’s

A 
Hypovolemia
Hypoxia
Hyper/Hypokalemia
     Hyper: tx = glucose
     Hypo: tx = K+ IVPB
Hyper/Hypothermia
Hydrogen ions (acidosis): tx = increase RR
Hypoglycemia
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39
Q

Causes of PEA: 5 T’s

A 
Tablets (drug OD): call poison control
Tamponade: pericardiocentesis
Tension pneumo: chest tube
Thrombosis (coronary and pulmonary): remove clot
     MI: tx = cath lab
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40
Q

Cardioversion vs. Defribrillation

A

Synchronized vs Unsynchronized
Sedation vs No Sedation

Cardioversion: needs a pulse

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41
Q

Cardioversion: Implications

A

Unstable A. Fib/Flutter
Unstable SVT
Unstable V. Tach

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42
Q

Defibrillation: Implications

A

Pulseless V. Tach

V. Fib

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43
Q

Where should the defibrillator pads be placed?

A

Top right - Bottom left

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44
Q

What are pacemakers used to treat?

A

2nd Degree (Type II )Blocks and 3rd Degree AV Blocks

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45
Q

Which side of the heart is paced?

A

Right side ONLY

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46
Q

What shows pacing is active on an EKG?

A

A spike before the P (atrial pacing) and/or a spike before the QRS (ventricular pacing)

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47
Q

Invasive Pacer: Complications

A 
Infection/hematoma
PVCs
Under Sensing
Failure to Capture
Failure to Discharge
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48
Q

What happens in “Under Sensing”?

A

pacer doesn’t recognize a normal heart rhythm and paces anyway

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49
Q

What happens in “Failure to Capture”?

A

Pacer attempts to pace, but no QRS is formed

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50
Q

What happens in “Failure to Discharge”?

A

The pacer does not deliver a stimulus to the heart

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51
Q

Pacemaker: Pre-op Care

A
  • Consent signed
  • NPO (start IV for emergency meds if needed and for abx)
  • Local anesthetic

Procedure in cath lab or OR

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52
Q

What conditions are included in Acute Coronary Syndrome (ACS)?

A

Unstable angina
Non-ST Elevation MI (NSTEMI)
ST Elevation MI (STEMI)

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53
Q

What causes Angina Pectoris?

A

Temporary imbalance b/w O2 supply and cardiac demand

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54
Q

Stable Angina: Characteristics

A

Predictable pattern

Relieved by rest and/or a little Nitro

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55
Q

Unstable Angina: Characteristics

A 
More intense pain
S/S at rest
Poorly relieved by rest or Nitro
May have ST depression
No Troponin or CKMB changes

Increased MI risk

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56
Q

Variant (Prinzmetal’s) Angina: Cause

A

Due to coronary vasospasm (cold, stress, meds, smoking, or cocaine)

57
Q

Variant Angina: Characteristics

A
  • Occurs at rest and at the same time daily (midnight - 8am)
  • Responds well to nitro and Ca Channel Blockers

Lower MI risk than unstable angina

58
Q

Myocardial Infarction (MI)

A

The heart muscle is severely deprived of oxygen

Blood flow dropped by 80 % - 90%

59
Q

Which is worse? STEMI or NSTEMI

A

STEMI: complete occlusion of a coronary vessel

60
Q

MI: Risk Factors

A
  • Age (>65)
  • Elderly: s/s = generalized weakness, stroke, syncope, change in mental status
  • Low estrogen
  • Family hx of CAD
  • Smoking
  • High cholesterol
  • Sedentary lifestyle
  • Diabetes
  • HTN
  • Obese
61
Q

Metabolic Syndrome: Risk Factors

A
  • HTN: BP>130/85
  • High Triglycerides: >150
  • High Fasting BG: >110
  • Large Waist: >40” males, >35” females
62
Q

Women Heart Disease S/S

A

Atypical Symptoms:

  • Abd pain
  • Pain b/w shoulder blades
  • Neck pain

More likely to have non-STEMI than men

63
Q

Process of Infarction: General

A

E-lyte imbalance and acidosis = change in conduction and contractility

Increased Epi/NorEpi = increased O2 demand and cardiac workload

64
Q

Process of Infarction: EKG Changes

A

1st) T Wave Inversion (ST depression)
2nd) ST Elevation (ACT FAST to prevent muscle injury)
3rd) Q Wave formation (necrosis = Q wave doesn’t resolve)

65
Q

Which side of the heart has the AV and SA nodes?

A

Right side

66
Q

What causes Bradycardia?

A

Inferior MI

67
Q

What is occluded in an Inferior MI?

A

RCA (affects the SA and AV nodes)

II, III, AVF

68
Q

What can Inferior MI cause?

A

Bradycardias and AV blocks

69
Q

What is the main sign of an Inferior MI?

A

JVD

70
Q

What is occluded in an Anterior or Septal MI?

A

LAD

V1-V6

71
Q

Which has a higher mortality? Anterior/Septal or Inferior MI

A

Anterior/Septal MI

72
Q

What can Anterior/Septal MI cause?

A

Ventricular dysrhythmia (V tach/V fib)

73
Q

What is the function of an intra-aortic balloon pump?

A

To reduce the cardiac workload

74
Q

What can cause JVD?

A

Inferior MI or Tricuspid issues

75
Q

MI: S/S

A 
-Pain/Discomfort in jaw, back, shoulder/abd
     >30 mins
Common:
-N/V
-Diaphoresis (sweating)
-Dyspnea
-Anxiety
-Fever (as high as 102)
-New A. Fib onset
76
Q

Chest Pain Assessment: Acronym

A

PQRST

P: Precipitate (what happens before the pain?)
Q: Quality
R: Radiates (pain)
S: Severity
T: Timing (when, previous episodes?)
77
Q

Cardiac Enzymes: MI

A

Troponin and CKMB Increase

78
Q

ACS Interventions: Goals

A
  • Relieve pain
  • Stabilize hemodynamics
  • Restore perfusion (get pt. to cath lab <90 minutes)
79
Q

ACS Emergency Interventions

A

-ABC, defibrillate (V. Fib, V. Tach, No pulse)
-O2 if sat <90%
-Continuous EKG, VS, IV
-ASA as ordered (anti-platelets)
Give rectally if N/V
S/E to monitor:
-Bleeding
-Tinnitus (ASA toxicity symptom)

80
Q

ACS Pain Relief

A

NTG (Nitro)
-if BP >90, HR 50-100
-not if “phosphodiesterase inhibitors” in past 24-48
ED meds = drastic BP fall
Morphine Sulfate (if pain doesn’t respond to NTG)

81
Q

Morphine Sulfate: Implications

A

Given to reduce pain and cause vasodilation

S/E: RR depression, vomiting, hypotension

Narcan if OD
Fluids if hypotension

82
Q

Chest Pain Treatment Acronym

A

MONA

M: morphine
O: oxygen (if <90%)
N: nitro
A: aspirin

83
Q

Reperfusion Strategies Post-MI

A

PCI (best option)
-must be <90 min since onset

Thrombolytics (“-ase”)

 - Give if onset <12 hrs
 - Door to needle <30 min

Over 12 hrs, revert to PCI

84
Q

Fibrinolytic: Contraindications

A
  • Symptoms suspected of aortic dissection
  • Active bleeding (not menses)
  • Any prior brain bleeds or known brain lesions
  • Significant closed head trauma in past 3 months
85
Q

Fibrinolytic: Post-Care

A
  • Clotting studies
  • Neuro assessment
  • Check stools, urine, and emesis for blood
  • Check IV patency
  • Monitor for S/S of reperfusion
86
Q

S/S of Reperfusion

A
  • No pain
  • Sudden burst (non-sustained) V. Tach
  • ST segment normalized
87
Q

MI: Complications

A

-Lethal dysrhythmias in 1st hr
V. Tach or V. Fib = common COD
PVCs

-Pericarditis
1 to 12 weeks post MI

-Septal Wall Rupture
DEADLY!
Rare

-HF

88
Q

MI Complication: Right HF (RCA infarct)

A
  • admin fluids
  • Beware of volume depleting drugs

Must maintain preload to manage BP and CO

89
Q

MI Complication: Left HF (LAD infarct)

A
  • Diuretics
  • Vasodilators
  • Inotropics
90
Q

MI Complication: Cardiogenic Shock

A

Left ventricle damage >40%
Mortality 65-100%

S/S: tachycardia, hypotension, pulmonary congestion, low UOP, cold/clammy skin, severe chest pain

Tx: stabilize with intra-aortic balloon pump (decrease workload of heart)

91
Q

Intra-Aortic Balloon Pump (IABP)

A

Inflates: diastole (heart relaxes)
Deflates: systole (heart contracts)

Reduces cardiac workload

92
Q

MI: Teaching

A
  • Risk factor modification
  • Activity
  • Diet (low fat, cholesterol, and Na)
  • Meds
  • Follow up appointments
  • VS (take own pulse)
  • Sex (can walk up stairs w/o angina)
93
Q

CABG: Post-Op Care

A
  • Fluid/E-lyte balance (Potassium**)
  • Maintain CO, VS, and temp
  • Pain management
  • Extubate as soon as stable
  • Neurovascular Assessment
  • Monitor Chest Tube output
94
Q

Potassium Normal Levels

A

3.5 - 5.0

95
Q

Normal UOP

A

1 mL/hr/kg or 30 mL/hr

96
Q

What does a sudden cessation of Chest Tube Drainage mean?

A

Clotting (can lead to cardiac tamponade!)

97
Q

Cardiac Tamponade: S/S

A
  • JVD, clear lungs*
  • Diminished heart sounds*
  • Tachycardia
  • Hypotension*
  • Pulsus Paradoxus (BP drop with inspiration)
98
Q

Heparin Induced Thrombocytopenia and Thrombosis (HITT)

A
  • Low platelets

- Immune response to Heparin = antibodies forming a clot in vessel walls

99
Q

HITT: Risk Factors

A
  • Onset 5 to 10 days after Heparin initiation
  • Female
  • Higher incidence in post surgical
100
Q

HITT: Clinical Manifestation

A

Plt: <100,000 or 50% of baseline*

Thrombus Formation: DVT (50%), PE (25%), Stroke, Death

101
Q

Platelets: Normal Value

A

150,000 - 400,000

102
Q

Spontaneous Bleeding Plt Level

A

<20,000

103
Q

HIT: Management

A

-CBC: to monitor plt level
-DC all heparin meds (“-parin”)
i.e. Lovenox (enoxaparin)
-Use alternative anti-coags
Factor Xa
Warfarin

104
Q

Post-CABG: Activity

A
  • No lifting >15 lbs
  • No driving, lifting, pulling for 6 weeks
  • Activity as tolerated (rehab potentially)
  • May resume sex: when can walk 1 block or 2 flights of stairs w/o SOB
105
Q

Post-CABG: Report

A
  • Red Incision
  • Swollen/area around incision feels warm
  • Drainage
  • Fever >100.5
  • Unusual chest pain, SOB, S/S of before surgery
  • Daily weight: alert if gain of 6 lbs in 2 days
106
Q

What is Heart Failure?

A

Pump failure = inability to maintain adequate CO

107
Q

HF: Types

A

Left Sided
Right Sided
High Output

108
Q

Left CHF (Congestive Heart Failure)

A

Can’t contract during systole
Can’t relax during diastole

Etiology: HTN, MI, Structural damage (valve issue)

109
Q

Left CHF: affected valves/potential cause

A

Mitral & Aortic

Anterior MI

110
Q

Right CHF: affected valves/potential cause

A

Tricuspid & Pulmonic

Inferior MI

111
Q

Left CHF: S/S

A
  • Dyspnea
  • Pulmonary issues
  • Decreased CO
  • Extra heart sounds/heart gallop

May lead to R. HF

112
Q

Right HF: Etiology

A

Most Commonly - CHF (L. HF)

113
Q

Right HF: S/S

A
  • Systemic Congestion

- JVD

114
Q

Why do you give ACE Inhibitors post-MI?

A

To prevent hypertrophic remodeling

115
Q

SNS Compensatory Reaction

A

Increase HR

116
Q

RAAS Compensatory Reaction

A

Increase volume/Decrease UOP

117
Q

Neurohormonal Response to HF

A

Endothelin (vasoconstrictor) = worsened HF s/s

BNP (vasodilator and diuretic)

118
Q

What does high BNP indicate?

A

Heart Failure

119
Q

High BNP Treatment

A

Lasix

120
Q

HF: Diagnostics

A
  • Chest X-ray
  • ECG
  • BNP Level (>90)
121
Q

Hemodynamic Monitoring

A

Wedge Pressure: Left
CVP: Right

Lowered = Low CO

122
Q

CO: Normal Value

A

4 - 8 L/min

123
Q

RA/CVP: Normal Value

A

2 - 6 mmHg

124
Q

PCWP (Wedge): Normal Value

A

8 - 12 mmHg

125
Q

SVR: Normal Value

A

800 - 1,400

High = vasoconstriction
Low = vasodilation
126
Q

HF Treatment:

  • Increased Preload
  • Increased Afterload
  • Decreased Contractility
A

Preload: give diuretic

Afterload: give morphine and Nitrates

Contractility: give Dobutamine

127
Q

HF Treatment Goals

A
  • S/S relief
  • Increased exercise capacity
  • Improve survival
  • Meds as ordered
128
Q

HF in Older Adults: Considerations

A

No NSAIDS!
Can exacerbate HF
Can cause H2O and NA retention

129
Q

Pulmonary Edema

A

Severe S/E of L. HF (CHF)

Fluid leaks into the lungs, airways, and tissues

130
Q

Pulmonary Edema: S/S

A
  • Sudden onset
  • Crackles
  • Disorientation
  • Extremely Anxious/Restless
  • Struggling for air
  • Moist, pink, frothy sputum
  • Tachycardia
  • Hyper/Hypotension
131
Q

Pulmonary Edema: Management

A
  • Airway (possible intubation)
  • High Fowler’s
  • Morphine
  • Nitro
  • Diuretics
  • Dobutamine
132
Q

When to stop activity with HF?

A

BP change of >20 mmHg

HR increase of >20 bpm

133
Q

Heart Transplant Criteria

A
  • Life expectancy <1 yr w/o transplant
  • Age <65 (or very healthy)
  • No infection, alcohol, or drug use
134
Q

Orthotopic Heart Transplant

A
  • Part of Original Atria left
  • Vagus nerve is severed (atropine doesn’t work anymore)
  • 2 unrelated P waves
135
Q

Heart Transplant: Post-op Care

A

-Denervated heart unresponsive to vagal stimulation
-Responds slowly to stress, exercise, position changes
May need a pacemaker

136
Q

Worsening HF: S/S

A

Call HCP if:

  • Rapid weight gain
  • Decrease in activity tolerance
  • Excessive nocturia
  • Orthopnea, dyspnea, or chest pain at rest (can’t lie flat anymore)
  • Increased edema
137
Q

Sleep Apnea

A

Directly related to CAD d/t diminishedO2 during apnea episodes

Tx: CPAP (improves CO and EF by decreasing preload, afterload, and BP)

138
Q

Pacemaker Post-op Teaching

A
  • Report S/S of pre-pacer
  • Don’t stand too close to microwave when using
  • No scanner at airport
  • Avoid electromagnetic fields
139
Q

ICD Teaching

A
  • Report to HCP if it has to cardiovert (fires)

- Family needs to learn CPR in case cardiovert stops the heart

Adult Health 3 (12 decks)

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